化生性乳腺癌的研究进展

Research development of metaplastic breast cancer

目的了解化生性乳腺癌(MBC)的发病机制、临床表现、诊断、治疗及预后情况,为临床诊治、科研探索等方面提供新的思路。方法对有关MBC的最新研究的相关文献进行综述并分析。结果目前,MBC的发病机制仍不确定。MBC发病率较低,临床表现缺乏特异性,与浸润性乳腺癌相比,MBC的肿瘤体积更大、生长更快、分化程度更低,其局部及远处转移风险较高而淋巴结转移较少见。由于MBC的临床表现、辅助检查及影像学检查均缺乏特异性,诊断困难,虽然术前穿刺可提供较为可靠的诊断依据,但由于其亚型较多,区分及确诊也较为困难,一些具有特异性的分子靶点可以提供一定的帮助。目前治疗仍多采用乳腺癌改良根治术,由于其腋窝淋巴结转移相对少见,因而前哨淋巴结活检仍具有重要地位;内分泌治疗、靶向治疗及新辅助化疗的作用有限,系统性化疗无明显的疗效;虽然放化疗可以提高患者的总存活率并延长无病生存期及控制其局部复发,但是由于MBC分型多,生物学特征独特,治疗效果差异较大。结论 MBC恶性度高、侵袭性强及分类复杂;临床表现及术前检查均缺乏特异性,容易造成误诊或漏诊;缺乏统一的治疗指南,预后差;为了达到更好的治疗效果需要进一步探索新的治疗方式及制定规范的治疗指南。

Objective To understand pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of metaplastic breast cancer （MBC）, and to provide some new ideas for clinical diagnosis and treatment, and exploration of scientific research for it. Method The relevant literatures of the latest research on MBC were reviewed and analyzed. Results At present, the pathogenesis of the MBC was still uncertain. The incidence of the MBC was lower, and it＇s clinical manifestations were not specific. Compared with the invasive breast cancer, the tumor diameter was larger, the growth was faster, the differentiation degree was lower, the risks of the local and distant metastases were higher, while the lymph node metastasis was rare. Because of the clinical manifestation, auxiliary examination, and imaging examinations were lack of specificity, the diagnosis was difficult. Although the preoperative puncture could provide a reliable diagnosis evidence, it was difficult for distinguishing and accurate diagnosis due to it＇s more subtypings. Some of the specific molecular targets could provide a help for it. At present, the modified radical mastectomy was often performed, the axillary lymph node metastasis was relatively rare in the MBC, so the sentinel lymph node biopsy was more important in the treatment of the MBC. The therapeutic effect was limited by the endocrine therapy, targeted therapy, or neoadjuvant chemotherapy and was poor by the systemic chemotherapy. Although the radiotherapy and chemotherapy could improve the overall survival and prolong the disease-free survival and control the local recurrence, the difference of it＇s therapeutic effect was great due to the complex MBC typing. Conclusions MBC is a highly malignant and strongly invasive tumor, and it has more subtypings. Clinical manifestation and preoperative examination are lack of specificity, hence it is easy for misdiagnosis or missed diagnosis. Unified treatment guideline is lack of, prognosis is poor. So, it needs to explore some new treatment methods and formulate standardized treatment guidelines in order to achieve a better therapeutic effect.